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Myocardial perfusion imaging with a cadmium zinc telluride-based gamma camera versus invasive fractional flow reserve

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

Recently introduced ultrafast cardiac SPECT cameras with cadmium zinc telluride-based (CZT) detectors may provide superior image quality allowing faster acquisition with reduced radiation doses. Although the level of concordance between conventional SPECT and invasive fractional flow reserve (FFR) measurement has been studied, that between FFR and CZT-based SPECT is not yet known. Therefore, we aimed to assess the level of concordance between CZT SPECT and FFR in a large patient group with stable coronary artery disease.

Methods

Both invasive FFR and myocardial perfusion imaging with a CZT-based SPECT camera, using Tc-tetrofosmin as tracer, were performed in 100 patients with stable angina and intermediate grade stenosis on invasive coronary angiography. A cut-off value of <0.75 was used to define abnormal FFR.

Results

The mean age of the patients was 64 ± 11 years, and 64 % were men. SPECT demonstrated ischaemia in 31 % of the patients, and 20 % had FFR <0.75. The concordance between CZT SPECT and FFR was 73 % on a per-patient basis and 79 % on a per-vessel basis. Discordant findings were more often seen in older patients and were mainly (19 %) the result of ischaemic SPECT findings in patients with FFR ≥0.75, whereas only 8 % had an abnormal FFR without ischaemia as demonstrated by CZT SPECT.

Conclusion

Only 20 – 30 % of patients with intermediate coronary stenoses had significant ischaemia as assessed by CZT SPECT or invasive FFR. CZT SPECT showed a modest degree of concordance with FFR, which is comparable with previous results with conventional SPECT. Further investigations are particularly necessary in patients with normal SPECT and abnormal FFR, especially to determine whether these patients should undergo revascularization.

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Authors and Affiliations

  1. Department of Cardiology, Isala klinieken, Dokter van Heesweg 2, 8025 AB, Zwolle, The Netherlands

    Mohamed Mouden, Jan Paul Ottervanger & Jorik R. Timmer

  2. Department of Nuclear Medicine, Isala klinieken, Zwolle, The Netherlands

    Mohamed Mouden, Siert Knollema, Stoffer Reiffers, Ad H. J. Oostdijk & Pieter L. Jager

  3. Department of Cardiology, University Medical Centre Nijmegen, Nijmegen, The Netherlands

    Menko-Jan de Boer

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  1. Mohamed Mouden
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  2. Jan Paul Ottervanger
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Correspondence to Mohamed Mouden.

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Mouden, M., Ottervanger, J.P., Knollema, S. et al. Myocardial perfusion imaging with a cadmium zinc telluride-based gamma camera versus invasive fractional flow reserve. Eur J Nucl Med Mol Imaging 41, 956–962 (2014). https://doi.org/10.1007/s00259-013-2630-5

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  • DOI: https://doi.org/10.1007/s00259-013-2630-5

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